Luijcks Nienke M, Visser Annelies, Dongelmans Dave A, van Dongen Dimmy M G, de Graaf Erin L, Groeneweg Jop, van der Laan Maarten J, Marang-van de Mheen Perla J
Department of Safety & Security Science, Delft University of Technology, Mekelweg 5, Delft, 2628 CD, The Netherlands.
Department of Surgery, Amsterdam University Medical Centre, Meibergdreef 9, Amsterdam, 1105 AZ, The Netherlands.
Int J Qual Health Care. 2025 Jul 4;37(3). doi: 10.1093/intqhc/mzaf074.
To improve healthcare processes, gaining a thorough understanding of the work is important. The Functional Resonance Analysis Method (FRAM) is a method that can be used for this purpose by visualising how different steps in a process interact. However, little research is available on the use and feasibility of FRAM in quality improvement studies. Therefore, the objective of this study is to assess the feasibility of using FRAM visualisations in a quality improvement study to identify, formulate and test improvement strategies regarding anticoagulant use in the perioperative process in two Dutch University Medical Centres.
Through multiple Plan-Do-Study-Act cycles, FRAM visualisations of work-as-imagined and work-as-done were created, which were validated and discussed with healthcare professionals through focus groups. Improvement suggestions were collected as input for improvement strategies from frontline clinicians. These strategies were tested and evaluated using questionnaires and interviews. The interviews were analysed using content analysis to further explore the value of the FRAM visualisations for identifying and employing improvement strategies.
The FRAM visualisations were perceived as confusing by professionals given their limited knowledge of FRAM, and it was time-intensive to identify possible improvements in the perioperative process. Using a simplified visualisation that showed the key FRAM information resulted in multiple improvement suggestions which were successfully tested as improvement strategies. The content analysis revealed three themes related to the use of FRAM: how care could be organised efficiently and safely, bringing stakeholders together to highlight the roles and responsibilities of professionals, and identifying how documentation of patient information is often scattered or incomplete.
FRAM visualisations in quality improvement studies can provide valuable insights into the working process, which are also useful for formulating and testing improvement strategies. However, adjustments to the visualisations are necessary to enable professionals to participate in identifying improvement strategies.
为改善医疗保健流程，全面了解工作情况很重要。功能共振分析方法（FRAM）是一种可用于此目的的方法，它通过可视化流程中不同步骤之间的相互作用来实现。然而，关于FRAM在质量改进研究中的应用和可行性的研究很少。因此，本研究的目的是评估在一项质量改进研究中使用FRAM可视化来识别、制定和测试关于荷兰两家大学医学中心围手术期抗凝剂使用的改进策略的可行性。
通过多个计划-执行-研究-行动循环，创建了设想中的工作和实际完成的工作的FRAM可视化，并通过焦点小组与医疗保健专业人员进行了验证和讨论。从前线临床医生那里收集改进建议，作为改进策略的输入。使用问卷和访谈对这些策略进行测试和评估。使用内容分析法对访谈进行分析，以进一步探索FRAM可视化在识别和采用改进策略方面的价值。
由于专业人员对FRAM的了解有限，他们认为FRAM可视化令人困惑，并且识别围手术期流程中可能的改进需要耗费大量时间。使用显示关键FRAM信息的简化可视化产生了多个改进建议，这些建议作为改进策略成功进行了测试。内容分析揭示了与FRAM使用相关的三个主题：如何高效、安全地组织护理，让利益相关者聚集在一起以突出专业人员的角色和责任，以及识别患者信息文档通常如何分散或不完整。
质量改进研究中的FRAM可视化可以为工作流程提供有价值的见解，这对于制定和测试改进策略也很有用。然而，有必要对可视化进行调整，以使专业人员能够参与识别改进策略。
